The Future of Medicine After COVID-19—Pt.2

From the Midstory Studio, our team chats with Angela Williams, a medical student at the University of Toledo, about her future and the future of medicine, including how medical schools are responding to the pandemic, what medical education may look like in the future and what she hopes changes in the medical field for the next generation of doctors.

Wherever the art of medicine is loved, there is also a love of humanity.

– Hippocrates

Browse by topic or read the transcript of our interview below.

Topics covered:[0:40] Current medical schooling and early graduation[3:07] Conflicting practice of hospital PPE policies[5:56] Unpreparedness of medical professionals and students for a pandemic[9:47] Insight into proper public health and public safety protocol[13:49] Shifting perspective of medical students towards the pandemic[16:54] Social pressure placed on medical professionals[20:41] Taiwan’s response to COVID-19[24:51] Humility and learning from the pandemic

Logan Sander: I’m excited to introduce our next guest, who is the second of a two-part installment featuring perspectives from medical students looking toward their future in medicine amidst COVID-19. Catherine Chen is currently pursuing her medical degree at the University of Toledo’s College of Medicine. This is after having received her bachelor’s in Biology and Psychology and her master’s in Bioethics from Case Western Reserve University. Well, thank you so much for being here, Catherine. I’m really excited to talk with you today.

Katherine Chen: Yeah, thank you so much for having me.

LS: As a medical student, you’re in your fourth year potentially looking at residency coming up really soon. What’s been your perspective so far on the virus, on the outbreak and has it impacted your life?

KC: Yeah, I actually think being a fourth-year medical student holds a very unique role with this COVID pandemic, because we actually got really lucky, I have to say, because a lot of medical education has been disrupted in terms of licensing, board exams, even just clinical rotations. It’s no longer safe for anyone to do any of that, and thankfully I had completed all of my core rotations, all of my electives, have been done with all my board exams for some time now. So I got pretty lucky. About the only things that really got disrupted for me in terms of my medical education were things like Match Day, not being able to celebrate with friends, graduation being cancelled, things that, sort of, all students across the nation are dealing with. So, I actually find myself pretty fortunate in terms of that because there wasn’t too much of a problem there.

I think the one thing that has been really interesting to me actually, is this whole concept of early graduation. And I’m not sure if you heard much about what’s happening in the medical school field with that. But in certain states that COVID’s been impacting the hospitals tremendously, they’ve been asking the medical students to graduate early in my class so they can go and be a part of the workforce, help them do patient intake, do orders, that type of stuff—things that we would be normally qualified to do as a first-year intern. And so New York, for instance, is one of those states that have asked all of the medical students or most of the medical students in their state to come in and be a part of the workforce early. Ohio actually isn’t thankfully. We’ve been really lucky about that relatively to all the other states, but a lot of my friends who did match in New York or who’ve matched in other states that are asking students to come in are now faced with this decision of whether or not they should go and start in the workforce, even if it’s in a specialty that they didn’t necessarily match into. And, I think that’s been kind of a different subject for all of us to be thinking about and pondering whether or not we should do it.

LS: Yeah, absolutely. I mean, it’s really difficult because you’re looking at students who are kind of pushed into something they were expecting a little bit more time for, and like you said, it may not be in their specialty. But, it’s also a huge kind of moral crisis because you’re thinking, “There’s people in need. There’s a huge crisis going on. There’s people who could use my expertise.” I mean what do you think a little about that struggle? I’m sure it would be difficult. Thankfully, you’re not in that position now, but if you were, I’m sure there’d be a lot of considerations.

KC: Absolutely. And my friends and I had been talking about this for quite some time now because we thought it was going to be a matter of weeks that we would hear back from our residency programs whether or not they wanted us to come. For the most part, I would say that most medical students have the mindset of saying, “Hey. We went into this profession because we wanted to serve our communities and we wanted to serve in the healthcare field. So if we were called to do so, we would do it.” I think there have been some concerns from the people in my class about the safety of all of it, especially with the lack of PPE. A lot of residents that I know now who are working in the ICUs or even the EDs, they only have one mask per day. They’re not allowed to take it off. They can’t throw them away. They have to basically treat the mask like it’s gold.And it’s kind of crazy because that’s not exactly the best way to use them either. In fact, the more you wear it, the less protective the gear becomes. And there have been a lot of environmental safety people that I’ve been talking to who say that if you don’t wear PPE correctly you might as well not be wearing it at all. It’s not very helpful at all.

So I think there are a lot of students and residents themselves who are in the field right now who think that it’s not fair that they have to be a part of this workforce that they can’t even work in safely. And as we’re learning more and more about the virus, we are learning that it can target younger individuals. And I think people are afraid of that, of getting sick and coming home and spreading it to their families, too. So really I think it just depends per person whether or not if you’re a medical student that you have the autonomy to decide if that’s a choice for you that you’re willing to take. I think that the biggest thing, though, is for medical students across the nation who are facing this dilemma that they have the autonomy themselves to decide and that it’s not a requirement in order for them to graduate, for instance, or it’s not like a forceful hand or they don’t feel like they are going into the workforce forcefully. But for the most part, I think a lot of us feel good about wanting to help out any way we can.

LS: Yeah. So, you talked a little bit about particularly things like PPE, so the way that you learn how to use it and a lot of things as I’m sure it’s true for almost every profession, but the things you learn in the textbook are not always the way things pan out in real-life settings. And I know you haven’t spent a lot of time in real-life settings in terms of the medical field yet. But what are some of those things you’re seeing that are different now that we’re in this pandemic? I mean PPE is one. As you mentioned, the usage of PPE is going against a lot of things that you learned of how to use them, but is there anything else?

KC: Yeah. Well, it’s interesting that you say that because about a few months ago, I was on one of my internal medicine electives. And as part of our curriculum, we have to sit through the grand rounds; so that’s basically one time a week in which they bring in a speaker either from our own hospital or from neighboring hospitals to speak to us about things that we should be educated on continuously. And in January, we were educated on COVID actually, and how we are supposed to move things forward because it hadn’t quite hit the U.S. the way it has been now. And so we learned about all these different things like, “this is how we’re supposed to set up our outpatient clinics,” for instance. Like say we have one person who comes in who potentially has some COVID exposure. How do we isolate them to make sure that they’re not infecting any of the other people who are in the waiting room? How do we make sure that our nurses who come in who are getting their history aren’t exposed in a way? How do we identify these people? Basically what I learned from the grand rounds is that we have these mechanisms in place that we learned from epidemics like SARS and MERS and that type of stuff, but unfortunately, we don’t practice these routines every day. And because we don’t practice these routines every day, we as healthcare professionals don’t think about making sure that our patients are isolated in a proper way, and done so safely for our healthcare professionals. So they had basically talked about the fact that you know if COVID were to come and hit us in Toledo, OH, that these were the steps that we need to take because currently we’re not ready. And I remember the speaker specifically talking about none of Ohio being ready if it did come to Ohio. And here we are.

LS: And here we are.

KC: Right. And I distinctly remember, about a month later, I was in an outpatient clinic. And I was about to go into this patient room before this nurse just stopped me, and she was like, “Hey, we don’t… I don’t want you to go in there, yet. We think this person just came from China about 14 days ago. We don’t know if we should keep him here or like call the CDC or call the Lucas County Health Department? We don’t know how to move forward.” And this slowed down our workforce so much. I couldn’t see any other patients because the room was filled and my attending, who has to come see the patient after me, also was falling behind his schedule. And it was just not very well done at the moment. This was back in February I believe. So I guess that’s like another way of being educated about a month before all of this happened and still not being ready for it and still having all of us as students involved and watching all of it pan out in the way that we don’t want it to pan out.

LS: Yeah. And maybe not even just in the next couple months, but maybe for a long time in the future. Just thinking about how medical education is going to change, how our health system and healthcare systems are going to change, our notions of public health and what it means to be a responsible citizen. I mean all of these notions are now in flux because of this huge global crisis. On the other hand, it’s definitely true that this experience has exposed a lot of the weaknesses across the board whether it’s in government or whether it’s even in our own response as citizens to something like this in terms of public safety, but also in our healthcare systems. And I’m sure you as an aspiring doctor, that’s something you’re about to enter into. And obviously, there’s been issues like not having enough beds, ICU beds, regular beds, ventilators, like you mentioned, not having enough PPE, not having particular protocol in place for something of this scale. Or maybe having the protocol, but realizing that when it really comes down to it, it’s really difficult to execute because of the systems in place. And I was also reading that there are, for example, restrictions on hospitals to be able to add more beds and it has to go through certain processes with the government. So there’s just so much red tape in place for things to get done quickly. And this is a moment where things have to be done quickly. I think we’ve all sort of, in some ways, woken up to that because this is a moment of crisis. But I’m wondering what your perspective is on all of that because that’s exactly what you are going to be entering into. And what might change? I mean, will things change? Hopefully they will.

KC: Right, right. I think one of the biggest things that, as you were speaking, I was thinking of is that even as a medical professional, like me in medical school and my colleagues who have been studying biochemistry for years, we don’t know nearly enough about what proper public health or proper public safety looks like. There’s a lot in medical education that we don’t learn about and you just sort of either have to number one, learn on the job, or number two, read about it on our own if you have a particular interest in it. I could see from a pandemic like this that the way our education is different in the future is that there would be more of an emphasis on what public health means and how we as healthcare professionals who aren’t necessarily trained in public health are still an integral component of it. I think before this pandemic became a pandemic a lot of us medical students were really worried about what the proper action was. You kept hearing things on the news. You kept hearing things happening in Europe and China and all the Asian countries and we just were kind of naive into thinking that it wouldn’t come here and affect us. And so a lot of us had all these plans of trips that we wanted to take or electives we wanted to be a part of. And we were like, “Oh COVID is no big deal! It’s just like a flu. We’re not gonna have to…” We were saying this, too, and we’re in the medical field. And it wasn’t until we were faced with the hard facts and the hard evidence of what was happening, and that our faculty and advisers are telling us, “Hey! This is actually a pretty big deal. We all need to educate ourselves on it,” did the perspective really change for our community. I think that was really tough for us because we go through four years of medical school not really knowing too much about it and now we’re faced head to head with it. Some words I’m sure a few of us are wishing we took back back in the day.

LS: Yeah, and when for you did that perspective change? When was that time when suddenly you realized this is not some foreign thing that I’m watching from across the world. This is something that’s going to impact everyday. It’s going to impact the way I live my life. It’s going to be a potential danger for so many people that I know and myself included?

KC: Yeah, yeah. For me, that was back I’m gonna say it was like March-ish, so not even that long ago, but I guess everything for the COVID pandemic has been happening pretty fast. It was probably late February or early March because for fourth-years, we tend to have a lot more time after our interview season. People want to go on trips, do fun things, things that we weren’t able to do before. And so many of us were saying things like, “Hey. We can still go on these trips. You know COVID is probably not gonna be that bad. Only the old people are affected.” Like really horrible things like that. At one point our Match Day was canceled because we weren’t allowed to congregate in groups greater than I think at that time it was 100. So we weren’t allowed to have big celebrations like that and people were really upset. People were like, “We worked so hard for four years.”

LS: So remind me that means that that’s the day you find out where you’re going for residency? And it’s like a big deal for your cohort because you’ve been working so long?

KC: Absolutely, it’s such a huge deal for so many people, and families are coming in from out of town. You’ve been working so hard to find out where you’re gonna spend your next four to seven years. And people talk about it as the best day of medical school basically. And so, it got cancelled for us and I think our community really had to look to ourselves to think, “What’s the best option here?” Some students are talking about creating our own Match Day not sponsored by the universities so that we could still celebrate. And then all the others of us were like, “Man, maybe this isn’t the best idea.” And so we had some interesting discussions among our classmates about how we are going to be perceived in the future if we do something like this. And it was really tough. Ultimately, obviously, none of that happened and all of us had decided that for the greater good, we couldn’t do something like that. But we were saying those things still at that time like, “It’s just a flu. Only people with comorbid conditions are at risk,” and not really thinking about the greater grand scheme of things and bringing in our older family, and if that would put them at risk—that type of stuff. That was pretty hard. And I think a lot of us didn’t really expect that because we weren’t in that public health mindset for such a long time. We’ve been studying so hard. We don’t know that much about what good public health measures look like. And after we were sharing some reading and discussing with each other, I think then we knew that it was time to take things seriously.

LS: Yeah. It looks like things are gonna be hard for health care professionals for a while. I mean, I know there’s been a lot of talk about… and a lot of great things. I know that now you see it all over social media. You see the 7:00 PM claps in New York City for the health care professionals during their shift change and people are talking so much about our health care heroes. It’s trending across the U.S. and across the globe, which is so great. But I’ve also seen some people talking about how we can applaud health care heroes and we should, but there’s also some things that they shouldn’t have to be facing. And you as an aspiring doctor going into that yourself. Or if you would have been a few more years ahead in your education, you could have been that personnel in the front line. We’re talking about understaffing, so you see doctors having to have super long shifts, staying extra shifts to deal with the crisis, like you mentioned, not having PPE, being put into situations where they’re not necessarily safe as well as the public doing things that are putting our health care workers more at risk, whether it’s congregating, gathering and doing things that could potentially create more spread. And they have a choice to stay at home. Our medical care professionals don’t have that choice most of the time. So what’s your thoughts about that as an aspiring medical person? Right? You would not want to be put in that situation. You very well could have been.

KC: Yeah. And that could very well look like next July for me. I think I start on labor and delivery nights and I can’t imagine what it would be like. I haven’t been in the hospital in months because of all of this. And I can’t imagine what it would be like to carry all that equipment with you to make sure that you are safe in order to do something as seemingly normal as deliver a baby. Yeah, it does make me really sad when you see things online and see things through our social media about people congregating and wanting their individual freedoms back, which I understand. This is tough on all of us. All of us have certain… we’ve all sacrificed to be where we’re at now, but it really saddens me when something like this isn’t taken seriously because people are dying in the hospitals without their loved ones. You can’t have visitors in the hospital anymore. I’ve had some of my resident friends tell me that when they have a loved one dying in the hospital from COVID that they will be Facetiming in their loved ones and congregating that way because they’re not allowed to have anyone in there. Since my particular specialty is OB/GYN, I’ve heard of labor and delivery floors where if you are scheduled to have a delivery around this time, some hospitals have not let you have a support partner. So your partner may not be there in the room with you. These are critical life moments that people aren’t having their loved ones around. And seeing people congregate and sort of not respect the sacrifices that all of us are making. We live life as normally as we can. It’s just really sad. I understand that it’s difficult for everyone. It’s just I hope that we can all see the bigger picture a little bit.

LS: Absolutely. You know some people say that the biggest tragedy would be that if we go through this horrible traumatic experience as a nation, as human beings, and we come out on the other end and we don’t change. Whether that’s individually or whether that’s on a healthcare level system, on a government level. What you, as a doctor-to-be, as someone who will be the next generation of people taking care of our citizens, what would you want that post-pandemic future to look like for the healthcare system, for your work and your field?

KC: Yeah, absolutely. I’ve been thinking about this a lot because talking to my friends, we’re just thinking, “Hey. When has there been a time like this ever again? SARS wasn’t really like this. This is sort of like new and novel for all of us and how can we learn from this and become better in case anything like this ever happens again? My parents are from Taiwan and Taiwan is a health care system that has been praised throughout a lot of news outlets about doing very well. It’s just so funny because my mom has been talking to me about COVID for months now, and for the first two months of it, I was like,”Mom, it’s not that big of a deal. Blah blah blah, all this stuff. don’t worry, but now I’m eating my words.

LS: I’m sure you’re not the only one.

KC: And now I’m just sitting here like, “Mom, you were right this entire time. Taiwan did everything right.

LS: I’m sure she loves to hear that, “Mom, you were right the whole time.”

KC: Yeah, she’s loving it. And so, one thing that has been big for her is that Taiwan has been a big product or has produced a lot of masks. And they aren’t in any shortage of any of that right now. In fact, if you can prove that you are a Taiwanese citizen or have that type of relationship with someone who lives in Taiwan, you can be sent 30 masks every two months.

LS: You can be sent masks even if you’re not in Taiwan?

KC: Yes.

LS: Wow.

KC: So my grandmother and my sister—my grandmother and my aunt, my mother’s sister, are being sent masks—or they’re sending masks to my mom here in Cleveland, which we can’t get anywhere. And it’s just amazing to me because, as I was thinking about this pandemic, you grow up in the United States, you train in the United States, never thinking that a scarcity of resources is something that you’ll ever have to encounter, and here we are with a scarcity of resources and having other countries come and help us. And my mom is using all of her resources to make sure that I’ll be safe in July. She’s gonna give me some of them because she’s afraid that when I start in July that there won’t be masks for me.

LS: I mean, it’s a real concern.

KC: Right, yeah. Exactly. So I think if there’s one thing that our U.S. healthcare system needs to recognize as we leave this pandemic, it’s that we are not as well off as we thought we were. We are not immune to losing or a lack of resources. In fact, we need to sort of look back and think—I think we need to look to countries like Taiwan and ask them how they were so good at protecting their citizens and protecting their healthcare workers, and maybe learn a few points from them, and maybe we wouldn’t be in as bad of a situation as now. I know that’s a really simplified answer to a very complex problem. I’m sure there are a lot more parts, including pieces within public health that Taiwan had accomplished that maybe we are not able to implement here, but, I mean, one of the biggest things is probably mass production.

LS: And something you were just talking about, too, in reference to Taiwan and how they’ve responded and, and, you know, how we’ve responded here. I mean, obviously Taiwan went through more closely the experiences with SARS and MERS, and sort of had those under their belt, you know, to be able to deal with this, but on the other hand, I think there was also a huge amount of humility in understanding that there’s just so much that we don’t know. That maybe we were a little late to the game in kind of recognizing that it’s better to be safe than sorry—[the phrase] is perhaps overused, but in this case is so applicable. Taiwan was, you know, distributing masks, was requiring people to be farther apart from each other, was sanitizing subway systems, etc., etc. etc. way before others thought that this was a huge deal. And I think maybe in the U.S., we were a little slow to the game, just because if we didn’t know that we needed to wear masks, we weren’t gonna wear masks, if we didn’t know that we needed to sanitize every day, we weren’t gonna sanitize every day.

KC: Absolutely, and I’m laughing right now because I’m seriously eating my words. Like, there were times where my mom was like, “Katherine, I know the CDC says not to wear masks right now because they should be reserved for health care professionals, but you know, in Taiwan, we always have this saying that it’s not just you protecting yourself, like you’re protecting other people by wearing them, too. And then I’d have to say, like three weeks later the CDC came out saying, “Well, we don’t have enough masks, but maybe any face covering will work.” My mother was just like, “I don’t know what to tell you! You know, I think we’re too slow on this type of stuff here in the U.S.,” and I have to say, you know, props to her, mother knows best, right?

LS: She sounds like a very wise woman. [Logan and Katherine laugh]

KC: Right.

LS: I mean, hopefully this is an opportunity for us to learn. I think there aren’t that many positives about this situation, but we hopefully should be able to come out of it, you know, with more experience, with more openness to learn, a sort of humility to look also to others who were able to handle this in a really proper and forward-thinking way—swift, quick, you know, and saved lives. And when it comes to life and death, you know, we can’t really afford to be prideful.

KC: Yeah, I completely agree with you there.

LS: Awesome. Well, thank you so much, it was really a pleasure to chat with you.

KC: Yeah, thank you for having me.

LS: Of course. Well, thank you all for joining us today on this episode of the Midpoint. I really enjoyed learning from Katherine about the dilemmas and hardships of being a medical student at this time, but also the hope for changes to come in the next generation of health care, which definitely can benefit from international experiences. If you like this video, like it, comment and share to support Midstory during this time. As always, stay safe, stay healthy and stay human. See you next time.

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